VALUE OF THE CLASSIFICATION OF INTRAOPERATIVE ADVERSE EVENTS (CLASSINTRA) FOR RESECTION OF CNS NEOPLASMS IN PEDIATRIC AND ADOLESCENT PATIENTS

Abstract OBJECTIVE: Outcome measuring is increasingly important in neurosurgery. Recently, a classification for assessing Intraoperative adverse events (iAE) was introduced (ClassIntra). We aimed to analyze the reliability of the ClassIntra to reflect Intraoperative complications and the potential to predict the outcome of pediatric and adolescent patients who underwent resection of CNS neoplasms. METHODS: A prospective study between 01 July and 31 December 2021 was conducted. The ClassIntra grade for each tumor resection was evaluated at sign-out (Grade 0 to V). Postoperative complications were graded after Clavien-Dindo and Comprehensive Complication Index (CCI). Neurological status was assessed prior surgery and at discharge using Lansky Index, NIHSS, NANO, GCS, and mRS. RESULTS: 21 pediatric and adolescent patients who underwent resection of CNS neoplasms were included. Of these, 8 (38.1%) were female with a mean (SD) age of 9.9 (5.2) years. During 13 (61.9%) resection an iAE was noted, of which 11 (52.4%) were classified as ClassIntra I and 2 (9.5%) as ClassIntra II. The majority (66.7%) underwent surgery for infratentorial pathology, whereas 4 (19.0%) had a supratentorial and 3 (14.3%) a spinal pathology. Preoperative characteristics did not correlate with the severity of ClassIntra. In patients without an iAE, a gross total resection was achieved more frequently (p=0.048). Focusing on postoperative outcome revealed a higher severity of cumulative complications as presented by the CCI (10.4 versus 40.5), longer hospital stay (p=0.04), and higher 30-day readmission rate (p<0.01) in patients with an iAE. However, the neurological outcome and time to begin of adjuvant treatment did not correlate with the ClassIntra. CONCLUSION: Findings of this study suggest that the ClassIntra is sensitive for assessing iAEs and sufficient to identify cases with a higher risk for developing postoperative complications after resection of CNS neoplasms in pediatric and adolescent patients, but cannot predict a possible neurological deterioration.